DESPITE years of Thatcherite attacks, the British National Health Service remains one of the most egalitarian healthcare systems in the world. In providing to each patient treatment according to their needs, while being funded from direct taxation which varies according to ability to pay, it embodies a basic tenet of Indeed the NHS is virtually unique among capitalist coun tries in delivering comprehensive care, funded from taxation, and free to all citizens at point of use.
By contrast many other health services are based on more expensive insurance systems, and many levy charges on patients for treatment and hospital stays as well as prescription drugs. In France, for example, charges on patients amount to a massive 19% of health spending.
Pushed through in 1948 by left wing Health Minister Aneurin Bevan, the NHS legislation effectively nationalised the existing hotch-potch of charitable and municipal hospitals. The state took over the funding of treatment from a ramshackle collection of insurance and other funds, which had left millions, notably women, without health cover.
pushed aside. Family doctors were brought in - at first grudgingly - as self-employed sub-contractors.
Like all post-war nationalisations in Britain (such as coal, rail and other utilities) the NHS was set up with serious problems. It established social ownership, but not social control. Instead, many of the old managers who had shamefully neglected and almost bankrupted the hospitals were left in charge: new health authorities were set up to replace the discredited Hospital Boards - but the authorities were always unelected and undemocratic.
Profits
Private drug companies and other suppliers were allowed to milk profits from the statefunded system, which from the outset was starved of the capital it needed to build new hospitals in expanding centres of population, and under-funded on its annual budget. In its first year the NHS cost £402 million, compared to a budget of £180m The new NHS could never achieve the dreams of the socialists who had campaigned hardest for it. It could not create an island of socialism in the midst of crisis-ridden capitalist society. Nor, for this reason, could it eradicate disease and ill-health, especially from working class communities wracked by poverty, poor housing and brutish working conditions. Some of the biggest advances in public health since 1948 have come from rising living standards rather than medical treatment.
However the NHS did make extremely important advances, and though Labour soon retreated and prescription charges and means-tested fees for dental treatment and spectacles were soon introduced, the vast bulk of NHS treatment - including all consultations and in-patient treatment - is still free of charge.
The attachment to this principle runs very deep: the unregenerate Thatcherite Michael Portillo is one of very few top Tories who now openly argue for 'hotel charges' to be levied on patients in hospital.
So while it is correct to highlight Tory under-funding of the NHS and to expose the problems created by growing waiting lists for treatment, it is important that socialists defend our health service.
Just remember: Bill Clinton's new plan for extending health insurance in the USA would leave working people liable to pay up to $3,000 a year in charges, including $10 for every visit to a doctor.
Even after 14 years of Thatcherism, we are far better off than that!